Articles tagged with: Ohio

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Samantha Mishne, LISW-S, LICDC

How do you move from a willful place to a willing place? I remind myself willingness is not a thing or a place; it is instead a view on life. Life is happening all around and I can either be willing to accept the change or feedback I receive, or I can be willful and in turn stay miserable, or say "yes, but". I think about this often with the clients I sit with who are asked or sometimes forced to make changes that are often times reinforced by the world we live in. The strength that they exhibit to move to a willing place is inspiring. I say to the young people who participate in family based treatment, your parents are going to reefed you, so you can either stay willful or move to a willing place. The nourishment that food provides often increased people's ability to a move to a willing place along with parents resolve to care for their children.

When trying to increase willingness the first thing I do is really try and listen to what it is that someone thinks or wants me to do, then I pro and con making the changes vs. staying the same. Ultimately what moves me to a willingness place is being witness to the change my clients make daily and my acceptance that change is constant. Though I say often that I do not like change the older I get the more I am realizing it is constant. You can only push a way for so long before you need to be willing. It is important to note that there are no shades of gray when it comes to willingness. Currently I am pushing away the water stain on my ceiling because I know I have a leak which I need to become willing to have someone come out and fix. Yes this is not as big an issue (no pun intended) as gaining weight, increasing meal plan compliance, not exercising . . .but it is an example of how every day we are faced with a choice to be willing or willful and we must accept the consequences. I will let you know if my ceiling falls in because I have yet to move to a willing place.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

We are very proud to announce our very own Mark Warren MD was voted a "2013 Best Doctor" by Cleveland Magazine! He was named by a national board of his peers. Pick up a print version to see the full listing, or read about the featured physicians.

"I'm so honored and thrilled to be acknowledged by my peers and community as a Best Doc," says Dr. Warren. "It's gratifying to know that all of our hard work at the Cleveland Center for Eating Disorders and our profound and unrelenting commitment to eating disorder treatment is getting noticed and making a difference in this field."

With this monumental achievement, we sat down with Dr. Warren to reflect on his career and accomplishments, where his passion for eating disorder treatment comes from, and what's next for him. Read on to learn more about Dr. Warren and why he continues to inspire us every day.

CCED: What is your area of expertise within the subject of eating disorders?

Dr. Warren: There are several areas that I have gained expertise in. The three that are my greatest focus are men and eating disorders, professionals with a history of eating disorders, and evidence-based therapies.

CCED: At what point in your training did you decide to specialize in the study of eating disorders, and why?

Dr. Warren: I went into the treatment of eating disorders after about 12 years of practice. I have a history of anorexia, which started in my teenage years. I was lucky to fall in love with (and for her to have been equally smitten) with a woman who successfully re-fed me. As there was no eating disorder treatment at the time, my own recovery was haphazard and spread out over many years.

Only after full recovery — not only being re-fed and stopping behaviors, but also feeling whole and having a good relationship with my body and with food — did I enter the field of eating disorder treatment. I then retrained in dialectical behavioral therapy, learned Maudsley Family Based Therapy, and began my full-time eating disorder work with Lucene Wisniewski, PhD — my partner here at CCED.

CCED: What is the most interesting or surprising thing you have learned about eating disorders over your years of research and practice?

Dr. Warren: I suppose it is how much sense they make when you are suffering from an eating disorder and how little sense they make to everyone else. Our new understanding of the biology of eating disorders and the brain has helped to make this separation so much clearer. I have great hopes that our further biological understanding will make eating disorders sensible to everyone and make clear how foolish and wrong it is to see eating disorders as a conscious choice.

CCED: If money were no object, what aspect of eating disorders would you most like to explore in research, or what resource/treatment would you most like to develop?

Dr. Warren: I would most like to explore in research how to develop treatments that help to stop the painful thoughts and feelings that accompany the disorder. We are getting better at re-feeding. We need to figure out how to help everyone with an eating disorder to experience a life worth living.

CCED: When you reflect on how far CCED has come since opening in 2006, what are you most proud of?

Dr. Warren: Before CCED, there was no way to get the most advanced, evidence-based care for eating disorders in Northeast Ohio. Patients either saw practitioners who were not using proven treatments or had to travel long distances to get the necessary care. We are still in a treatment environment where many providers either don't know what evidence-based care is or don't do the training needed to become an expert.

Now, for many patients, they can get the care they need, while staying at home. Eating disorders are deadly illnesses. Patients deserve the best practice of care from providers who have done the work to learn what has the highest likelihood of success. I am proud that CCED continuously strives to provide the best practice for all our patients.

CCED: What's next on your list?

Dr. Warren: We have three main goals:

Under the lead of Dr. Wisniewski, we have developed and implemented new therapies based on the best evidence and will continue to expand in this way.

Second, we need to continue to research our outcomes so we know how well we are doing and what we can do to make ourselves better. This work is already ongoing and we are publishing and presenting our outcome data, which both improves the work we do and helps the eating disorder field as a whole.

Third, we need to get the word out that there is real therapy, therapy based on a scientific model, for eating disorders. Pediatricians, therapists, family doctors, internists, Emergency Room doctors and, especially patients and their families, need to know that there is true help for those who suffer with eating disorders. When patients, providers and families work together, there is hope for recovery.

Thanks to those of you who joined us on Monday at "Body Beautiful," presented by Cleveland Center for Eating Disorders and John Carroll University. We had a great turnout! Students, professors, eating disorder professionals and families came out to increase awareness and promote hope around body image disorder and eating disorders.

The event, which ran in conjunction with National Eating Disorders Awareness Week, featured a student interactive art show, "Mirror Images" and a screening of the popular documentary, "America the Beautiful." Immediately following, our expert panel was there to answer questions from the audience.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Dr. Mark Warren

In the field of eating disorders, multiple studies have shown that Family Based Treatment (FBT) is the most effective method available to achieve successful weight restoration and maintenance after treatment is completed. Unfortunately, specific treatments for adults have not been shown to have the same long term benefits as FBT. Clearly there are many variables involved in this data, however there are elements to FBT that may point us to a better understanding of what happens for adults.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Dr. Mark Warren

A recent article in the International Journal of Eating Disorders by Couturier, Kimber, and Szatmari (2013) adds to the literature on the effectiveness of Maudsley Family Based Therapy (FBT). Their conclusion is that while FBT does not show superiority to other therapies during treatment, there are significant benefits at the 6 -12 month follow up. These benefits reach a level of significance that would cause one to recommend FBT for the treatment of eating disorders in adolescents instead of individual therapy. As they discuss in their article, there are multiple limitations to this study, however research literature has long pointed to the superiority of FBT over individual therapy. This article therefore adds to a growing body of data.

From a CCED perspective, we are particularly interested in what happens in those first 6 months and if there is a way to improve the outcome of FBT more rapidly for adolescents. Our clinical experience is that by adding higher levels of care, in particularly partial hospitalization in conjunction with FBT, that we can improve orientation, adherence, and effectiveness of FBT, while still staying in line with the FBT model. Our clinical experience does not meet the criteria of the research considered in this particular article, since it is not a randomized control trial or have a control group associated with it. However, given the data that we have, we hope to find that the utilization of FBT within a higher level of care may be a more rapid way to help our clients move from anorexia to recovery. We hope to publish in the next year on the results of our research into this question.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

We are happy to announce that today's post is written by psychologist Dr. Sarah Ravin. Dr. Ravin utilizes DBT, CBT and ACT to treat adolescents and young adults with eating disorders, body dissatisfaction, anxiety, depression, OCD, and self-injury. We have often linked to and are inspired by the posts on her blog. A big thank you to Dr. Ravin for her contribution to our blog!

If you have an eating disorder, you have probably struggled with the question of whether to reveal your diagnosis to others.

Teenagers and young adults with eating disorders run the gamut of self-disclosure: some of them never tell a single soul about their illness, while others write about it on Facebook or tweet about it daily to hundreds of followers. In my practice, I advise patients to think carefully before revealing their illness to anyone. In this age of tell-all books, tabloid magazines, and Jerry Springer, it is easy to forget that the concept of revealing deeply personal information to large numbers of people is relatively new and quite controversial. There are consequences – both positive and negative – to telling people about your eating disorder.

In considering whom to tell, it is important to balance the desire for privacy with the need for social support. On the one hand, having an illness is a personal matter and is not typically something you would share with a large number of people. Think about whom you would tell if you had asthma or a learning disability. Most people would share this information with their close friends, relatives, and doctors. Most people would not share this information on a first date, or on a job interview, or on their Facebook page.

On the other hand, someone going through an eating disorder needs a tremendous amount of support in order to get well. Friends and loved ones can only support you if they are aware that you are struggling and that you need their help. Suffering from an eating disorder can be a lonely and isolating experience, particularly if you keep your illness a secret from everyone.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

Males are historically underrepresented throughout the eating disorder field- as patients, treatment professionals, by diagnosis and prevalence, in research studies and in stories of recovery. 30 years ago men with eating disorders were virtually invisible and options for treatment were mostly non-existent. Fortunately, we are at a tipping point in our understanding of males and eating disorders. While major gaps still exist in our understanding, we are continuously learning more about males with ED.

According to the National Comorbidity Study (Hudson, 2007), lifetime prevalence in ED in men is:

Anorexia Nervosa- 0.3%

Bulimia Nervosa- 0.5%

Binge Eating Disorder- 2%

In this study, over 50% of men also had co-morbidities.

In a study by Striegel-Moore, et al in 2009, over 26% of men in the community had ED symptomatology.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Dr. Mark Warren

Every year our understanding of the brain and eating disorders improves. However, there are still a limited number of truly evidence based treatment for our patients. The search for evidence based care may feel overwhelming and sometimes futile. Unfortunately, moving in the direction of care that is not evidence based reduces the likelihood that clients will achieve recovery. There are several reasons why providers may offer care not based on the literature or published data:

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Dr. Mark Warren

Often times while in treatment clients wonder how and why their eating disorder developed. The common question "What caused my eating disorder?" is very complicated because it pulls from so many ideas, understandings, conceptions, and misconceptions about the importance of causation, the implication of causation, and the definition of what causation means. Before we deal with the notion of causation itself, it is crucial to point out there is no evidence that knowing causation leads to cure, and no current evidence that knowing cause provides an avenue to change the treatment that we do. Having said that, virtually all clients and families want to know why they have an eating disorder. We believe, and research has indicated, that there are biological factors that predispose an individual to the illness and environmental factors then influence the manifestation of the disorder. This mirrors most psychological illnesses. When you have a treatment that is purely biological for an illness it moves someone towards recovery, but usually they do not feel better until they have re-established the quality of life they had before the illness. This often means a re-establishment of social contacts, work, school, and the ability to experience personal growth, change, pleasure and happiness. So we are careful not to say that the lack of these things are the causes of the illness, even though attaining them may be a core part of the recovery process. The experience of cure does not need to flow directly from the notion of causation. We know that nourishment and cessation of behaviors is a prerequisite to getting better, and we also know that after stabilization of symptoms there is still much work to do. Our current understanding is that the work left to do is not due to underlying things that caused the illness, but rather issues that may persist after refeeding, issues of body image, negative self talk and shame, and the ability to experience oneself as whole and healthy.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Mark Warren, MD

The book Eating Disorders and the Brain edited by Drs Lask and Frampton continues to be an extraordinarily important book to understanding the etiology of eating disorders. Given our current knowledge, we often say that eating disorders are biologically based. Yet, this is somewhat of a two-dimensional statement as eating disorders are experienced as complex and multi factorial. A large number of factors seem to be interacting when someone presents with an eating disorder. These include genes, early attachment, personality issues, cultural issues, cultural norms, peer relationships, sensitivity, and on and on. Current biological work is beginning to show us is that many of these factors may in fact be related to one and other. The complex development of the eating disorder can be understood as the product of a specific genetic profile that develops in a specific individual under specific circumstances. Rigidity, perfectionism, skillfulness, and skill deficits, that are often seen in individuals with the illness are often mislabeled as "causes" when they are in fact part and parcel of the same developmental picture that may ultimately result in an eating disorder. With continued research of the brain, we are closer to understanding this complexity in terms of a specific biology that causes multiple expressions and can ultimately understood and treated through development and improvement of structures within the brain.

Anyone with an eating disorder has been asked at some point or another "Why don't you just eat?" Most likely if you have an eating disorder you have asked yourself the same question. You might wonder "Why is eating so hard for me when it seems to be so easy for everyone else?" On one level the answer to this is incredibly simple, and on another level incredibly complicated. The simple level is biology. Having an eating disorder means having neurological or neuroanatomical organization of your brain that creates enormous barriers to eating normally. These barriers include visual and sensory distortions, impacts on reward centers and executive organization of the brain, distortions of senses of fullness and hunger, and over evaluation of body size and shape, in addition to other issues that may be present. The combination of all of these things makes eating incredibly hard to do. The complex answer comes from the interaction of all the issues above in addition to the fact that eating itself is an activity that is way more complicated than people give it credit for. Eating is not just about seeing food, grabbing food and putting it in our mouths. Eating is about being aware of what's happening inside our bodies, understanding and appreciating our sensations, knowing what gives us pleasure and how to eat in a balanced way. Add social eating and societal influence and its clear that eating is a complex activity on many levels. So the answer to why can't I just eat is that you have an eating disorder and that in fact is what the disorder is. It's what makes it such a scary, painful, and life threatening disease. Having an eating disorder is confronting the question "Why can't I just do something that ultimately may save my life?" It's also what makes recovery from an eating disorder so rich, full, and rewarding. Because when you are able to "just eat", you are able to embrace life in a way that had never felt possible before.

Should you have an questions or comments regarding this post please email This email address is being protected from spambots. You need JavaScript enabled to view it..

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

A recent study by Dr. Janet Treasure, one of the world's most prominent eating disorder researchers, has demonstrated the significant importance of early and aggressive treatment for anorexia nervosa. In her study, regardless of the treatment mechanism, patients who had been ill for longer than three years had significantly worse outcomes after treatment then those who had been ill for less time. Give the lack of evidence based treatment available until ten years ago, we do not know if current treatment mechanism may be more effective for those who have been ill longer. However, we can certainly say that based on this study, the faster someone gets into treatment and the more aggressive the treatment, clients are faster into recovery and less likely to relapse.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

An interesting article from the Journal of Adolescent Health was recently profiled in the New York Times. This article challenges traditional methodologies for in-patient re-feeding of teenagers with anorexia nervosa. Historically, the protocol for teens hospitalized for anorexia has been to "start low and go slow" with food. However, this often results in much slower weight gain or even lack of weight gain during the first week of hospitalization and may result in a teen being discharged from the hospital at a significantly lower weight than they would have been if they had been re-fed more aggressively. As we know from other literature, not reaching prior growth curves is thought to be the single greatest factor in relapse for anorexia and hospitalization is often utilized to jump start this vital and necessary weight gain.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Dr. Mark Warren and Sarah Emerman

We've had a very busy year in 2011 and want to thank all of our blog readers for your support and interest. As the year comes to a close we hope this post finds everyone in good health and moving to new places of healing.

At CCED we know that as new research emerges we must constantly change and evolve to provide the most up to date evidence based care. In the spirit of constant improvement we have made several additions to our programming in the last few months.